- Nurse practitioners received a significant boost in compensation compared to other advanced practice registered nurses (APRNs), a new survey revealed.
The survey of over 3,200 advanced practice registered nurses (APRNs), including nurse practitioners, certified nurse specialists, certified registered nurse anesthetists, and nurse midwives, uncovered a six percent increase in nurse practitioner salary in 2017. Medscape conducted the survey.
Full-time nurse practitioners (NPs) earned an average of $112,000 in 2017 versus $106,000 the previous year.
Despite having the most significant boost in compensation, certified registered nurse anesthetists received the highest compensation compared to other APRNs. The specialty RNs earned an average yearly salary of $192,000 in 2017, accounting for a five percent boost in salary compared to the prior year.
Nurse midwives saw the second highest average gross income in 2017. The APRNs earned an average of $107,000, representing a four percent boost versus the previous year.
And certified nurse specialists received a one percent increase in annual compensation, reaching $103,000 in 2017.
Researchers pointed that APRNs reported significantly higher income compared to registered nurses who did not have an advanced practice designation. Compensation for registered nurses was $81,000, on average, in 2017.
Nurse practitioners had the opportunity to earn more in the hospital setting in 2017, the data also uncovered. NPs earned an average of $120,000 a year when working in inpatient care at a hospital.
In comparison, the lowest paying employment setting for NPs was the school or college health service setting where the average annual gross income was $95,000 in 2017.
The acute care hospital is the primary employment place for APRNs, but not nurse practitioners. Most NPs work in the hospital-based outpatient setting or clinic (24 percent of surveyed NPs) or the non-hospital-based medical office or urgent care center (26 percent).
Only 15 percent of NPs work in the acute care hospital versus 71 percent of certified registered nurse anesthetists, 42 percent of certified nurse specialists, and 24 percent of nurse midwives.
NPs favor other healthcare employment settings compared to their APRN peers. Notably, approximately two percent of NPs reported working in retail health clinics, researchers stated.
Additionally, the survey found that practice ownership was uncommon among all types of APRNs. Between four and 17 percent of all APRNs owned their own practice in 2017 despite practice owners earning 10 percent more than non-owners.
Practice ownership also did not significantly increase compared to 2016.
State laws may be hindering independent practice ownership among APRNs, researchers posited.
Many states require APRNs to collaborate with a physician to deliver billable healthcare services to patients. According to the survey between 75 to 79 percent of APRNs must have a collaborating physician and a collaborative practice agreement.
The only exception was among certified nurse specialists. About 43 percent of the providers reported being independent practitioners.
The Trump Administration, however, could pave the way for increased practice ownership among NPs and other APRNs. Several White House agencies, including HHS, recently called on states to relax or eliminate scope of practice laws that prevent providers from practicing at the top of their license.
The agencies also suggested accompanying legislative and administrative proposals that allow non-physician providers to get paid directly for delivering services.
“[E]ven well-intentioned regulations may impose unnecessary restrictions on provider supply and, therefore, competition,” the agencies contended. “Oftentimes, too, SOP [scope of practice] restrictions limit provider entry and ability to practice in ways that do not address demonstrable or substantial risks to consumer health and safety. When this happens, these undue restrictions are likely to reduce healthcare competition and harm consumers—including patients, and taxpayers more generally.”
Relaxing scope of practice laws like collaborative practice agreement requirements could also boost healthcare productivity, economists from the Hamilton Project recently said.
“Achieving productivity gains is one way to reduce cost pressures throughout the healthcare system and, ultimately, in government budgets. Productivity can be increased by using different combinations of labor and capital, as well as by using lower-cost sources of labor to achieve the same or better outcomes. Indeed, relatively high payment rates for physicians in the United States versus other developed countries make this a particularly appealing opportunity,” the group wrote.
“The lack of normal competitive forces in the healthcare sector, however, serves as a key barrier to achieving these efficiency gains. Currently, there are strong anticompetitive barriers to making more use of advanced practice providers in the healthcare sector.”
Supporters of scope of practice laws argue that relaxing the requirements on non-physician providers could lead to deteriorating care quality. But new research shows that NPs and physician assistants are delivering the same, or even higher, care quality than physicians.
For example, a new study from the Durham VA Health Care System in North Carolina, published in Annals of Internal Medicine, revealed that nurse practitioners and physician assistants provided similar care to people with diabetes. Researchers observed no significant differences in blood sugar, blood pressure, and cholesterol levels among patients treated by advanced practice providers and physicians.
In light of new research, the Medicare Payment Advisory Commission (MedPAC) pitched direct Medicare billing for APRNs and physician assistants at their Dec. 6 meeting. The advisory group recommended eliminating “incident to” billing, in which the organization uses the practicing physicians National Provider Identifier (NPI) for billing purposes.
“Incident to” billing for APRNs and physician assistants “obscures policymakers’ knowledge of who is providing care for beneficiaries, inhibits accurate valuation of fee schedule services, and increases Medicare and beneficiary spending,” MedPAC explained.
The advisory committee will consider the proposal for its next report to Congress in March 2019.